PB2345: MOGAMULIZUMAB IN MYCOSIS FUNGOIDES AND SÈZARY SYNDROME: AN ITALIAN SINGLE CENTER EXPERIENCE
Authors: Maria Pina Simula, Daniela Dessì, Sara Veronica Usai, Brunella Mola, Michela Schirru, Luca Deiana, Giorgio La Nasa
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Mycosis fungoides (MF) and Sèzary Syndrome (SS) are the most studied subtypes of Cutaneous T-Cell Lymphomas (CTCLs). MF is the most common disease and is mainly indolent, whereas SS is a rare condition with more aggressive behaviour. Both are characterized by heterogeneous clinical presentation and response to treatment and are generally incurable. The aim of therapy is to control symptoms and extension of cutaneous lesions and avoid disease progression. Recently, new drugs are available for the management of these diseases: one is Mogamulizumab, a first-in-class defucosylated humanized IgG1 κ monoclonal antibody approved by FDA and EMA in 2018 for the treatment of adult patients with relapsed or refractory (R/R) MF or SS after at least one prior systemic therapy. Aims: In this report we show the results of the analysis of nine patients with MF and SS R/R treated with Mogamulizumab at our Institution. Methods: We have collected and analised data of patients from medical records. Response was graded according to ISCT/USCLC/EORTC consensus guidelines. Results: Nine patients (3 F and 6 M) have received Mogamulizumab in our Department; three of them was affected by MF and 6 by SS; median age at diagnosis was 70 years (range 47-77), at mogamulizumab start was 71 (range 51-83) (Table 1). Median number of previous treatment was 3 (range 1-4); all of them but one had bexarotene, 7 had steroids, 4 interferon alpha, 3 monochemotherapy with Gemcitabine and 2 polichemotherapy (CHOP/CHOEP), 3 Psoralene Ultra-Violet A (PUVA), 1 radiotherapy and 2 photopheresis. The reason to start Mogamulizumab was progressive disease (PD) in 6 cases, the other patients had no response (stable disease, SD) to previous approaches. Median number of cycle of Mogamulizumab was 10 (range 1-22). Seven out of 9 received concomitant medication (5 bexarotene, 1 PUVA, 2 steroid, 1 clormetine gel). Best response achieved was as follow: skin response was complete (CR) in 1 patient, partial (PR) in 4 and SD in 4; lymphonodes response was: 2 PR, not evaluated (NE) in 2 and not applicable in 5(NA); blood response was assessed in SS: 4 CR, 1 PR and 1 SD; global response was: 1 CR (patient with MF), 5 PR (4 SS, 1 MF), 3 SD (2 SS, 1 MF). All patient complained pruritus that resolved in all of them with mogamulizumab alone or in combination therapy. Response in blood occured after 1 week in 4 patients and 4 weeks in 1; skin response was slower: occured in median 3 weeks (range 1-6). Median progression free survival was 9 months (range 1-21 months). Regarding side effect, we observed new skin lesions in 3 patients (grade 1), no biopsies was performed and local steroids were effective. Mogamulizumab was stopped for more than 1 months in 2 patients. The first had bowel perforation because of diverticulitis and some months later underwent recanalisation but shed did not lose response, the other one had sepsis and SARS COV 2 infection and interrupted mogamulizumab for 5 months showing PD. Mogamulizumab was restored in all cases, but in the patient with PD has failed to restore response. Summary/Conclusion: In our experience Mogamulizumab alone or in combination show good response and disease control in R/R patients with MF and SS. The treatment was well tolerated and no safety concern was noticed.Keywords: Cutaneous T-cell lymphoma, Mycosis fungoides